• Keith Couper, Peter K Kimani, Benjamin S Abella, Mehboob Chilwan, Matthew W Cooke, Robin P Davies, Richard A Field, Fang Gao, Sarah Quinton, Nigel Stallard, Sarah Woolley, Gavin D Perkins, and Cardiopulmonary Resuscitation Quality Improvement Initiative Collaborators.
• 1Heart of England NHS Foundation Trust, Birmingham, United Kingdom. 2Warwick Medical School, University of Warwick, Coventry, United Kingdom. 3Center for Resuscitation Science, University of Pennsylvania, Philadelphia, PA. 4School of Clinical and Experimental Medicine, College of Medical and Dental Science, University of Birmingham, Birmingham, United Kingdom.
• Crit. Care Med. 2015 Nov 1; 43 (11): 2321-31.

ObjectiveTo evaluate the effect of implementing real-time audiovisual feedback with and without postevent debriefing on survival and quality of cardiopulmonary resuscitation quality at in-hospital cardiac arrest.DesignA two-phase, multicentre prospective cohort study.SettingThree UK hospitals, all part of one National Health Service Acute Trust.PatientsOne thousand three hundred and ninety-five adult patients who sustained an in-hospital cardiac arrest at the study hospitals and were treated by hospital emergency teams between November 2009 and May 2013.InterventionsDuring phase 1, quality of cardiopulmonary resuscitation and patient outcomes were measured with no intervention implemented. During phase 2, staff at hospital 1 received real-time audiovisual feedback, whereas staff at hospital 2 received real-time audiovisual feedback supplemented by postevent debriefing. No intervention was implemented at hospital 3 during phase 2.Measurements And Main ResultsThe primary outcome was return of spontaneous circulation. Secondary endpoints included other patient-focused outcomes, such as survival to hospital discharge, and process-focused outcomes, such as chest compression depth. Random-effect logistic and linear regression models, adjusted for baseline patient characteristics, were used to analyze the effect of the interventions on study outcomes. In comparison with no intervention, neither real-time audiovisual feedback (adjusted odds ratio, 0.62; 95% CI, 0.31-1.22; p=0.17) nor real-time audiovisual feedback supplemented by postevent debriefing (adjusted odds ratio, 0.65; 95% CI, 0.35-1.21; p=0.17) was associated with a statistically significant improvement in return of spontaneous circulation or any process-focused outcome. Despite this, there was evidence of a system-wide improvement in phase 2, leading to improvements in return of spontaneous circulation (adjusted odds ratio, 1.87; 95% CI, 1.06-3.30; p=0.03) and process-focused outcomes.ConclusionsImplementation of real-time audiovisual feedback with or without postevent debriefing did not lead to a measured improvement in patient or process-focused outcomes at individual hospital sites. However, there was an unexplained system-wide improvement in return of spontaneous circulation and process-focused outcomes during the second phase of the study.

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